Arthroscopic Surgery of Irreparable Large or Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus: Patch Autograft Procedure Versus Partial Repair Procedure

Arthroscopic Partial Repair of Irreparable, Massive Rotator Cuff Tears

“…This technique has been shown to be effective in terms of recovery of muscle strength and improvement in postoperative outcomes; however, a notable retear rate of 41.7% has to be expected. 4 It is pivotal to properly clarify the indications for arthroscopic partial repair over other surgical possibilities. The arthroscopic-assisted latissimus dorsi tendon transfer has been proposed as a reasonable solution to restore function and decrease pain in patients with irreparable, massive RCTs.…”

“…technique 3 or its insertion within the medial footprint. 4 The principle of margin convergence applied to rotator cuff repair is achieved by side-to-side suture of the cuff tear to converge the free margin of the cuff toward its bone bed. This technique has been shown to reduce strain along the "converged" margin, thereby protecting the tendon-bone repair interface during the critical phases of healing.…”

Patch Augmentation for Massive Rotator Cuff Tears

“…Because these grafts originate from the person's own body, they are regarded as the gold-standard choice of graft. Studies on autografts have shown favorable clinical outcomes, [23][24][25] and the successful outcomes have been shown to be dependent on cells within scaffolds that activate collagen synthesis and, thereby, start the process of tendon re-formation. Accordingly, autografts with viable donor cells are preferred over frozen allografts with unviable donor cells.…”

Options Before Reverse Total Shoulder Replacement

“…Many varieties of patch materials have been developed and used clinically, including synthetic materials Polyester ligament (Dacron) [100], Gore-Tex soft tissue patch [101], Mersilene mesh [102], Teflon felt [103] and Carbon fibrebre patches [104], allografts freeze*dried rotator cuff [105,106], quadriceps tendon [107], patellar tendon, achilles tendon [107], dermal matrix (Graftjacket) [107], tensor fascia late [108] and xenografts porcine dermal collagen [109,110], porcine small intestinal submucosa [111]. Autografts such as the biceps tendon [112,113] and tensor fascia late [114] have also been used. Patch reinforcement can be performed as augmentation (onlay) of a cuff repair, in which the rotator cuff is repaired to nearly normal status and patch is then either implemented into the repair construct or sutured over the top of the repaired tendon [99].…”